NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW MEDICAL/ HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
If you have any questions about this notice, please contact the administrator of West Hartford Health & Rehabilitation Center. The effective date of this privacy notice is April 14, 2004.
At the facility, we respect the privacy and confidentiality of your health information. This Notice of Privacy Practices (“Notice”) describes how we may use and disclose your medical/health information and how you can get access to this information. This Notice applies to uses and disclosures we may make of all your health information whether created or received by us.
- I. Our responsibilities to you
- II. How we will use and how disclosure affects your health
- Information for treatment, payment, and health care operations
- III. Other uses and disclosures we many make without your written
- IV. Your written authorization is required for all other uses or
- disclosures of your health information.
- V. Your rights regarding your health information
- VI. Special regulations regarding disclosure of psychiatric and HIV-
- related information
- VII. Complaints
I. OUR RESPONSIBILITIES TO YOU
We are required by law to:
- Maintain the privacy of your health information and to provide you with notice of our legal duties and privacy practices.
- Comply with the terms of our Notice currently in effect.
We reserve the right to change our practices and to make the new provisions effective for all health information we maintain, including both health information we already have and health information we create or receive in the future. Should we make changes, we will make the revised notice available to you by posting it in a clear and prominent location.
II. HOW WE WILL USE AND HOW DISCLOSURE AFFECTS YOUR HEALTH INFORMATION FOR TREATMENT, PAYMENT AND HEALTH CARE OPERATIONS
We may use and disclose your health information for the purpose of treatment, payment and health care operations as described below.
- For Treatment:
We may use and disclose your health information to provide you with treatment and services and to coordinate your continuing care. Your health information may be used by doctors and nurses, as well as by lab technicians, dieticians, physical therapists, certified nursing assistants or other personnel involved in your care, both within our facility and by other health care providers involved in your care. For example, a pharmacist will need certain information to fill a prescription ordered by your doctor. We may also disclose your health information to persons or facilities that will be involved in your care after you leave our facility. For example, should you need home care services after you leave the facility, we may disclose information to the Home Care Agency that will provide those services.
- For Payment:
We may use and disclose your health information so that we can bill and receive payment for the treatment and services you receive. For billing and payment purposes, we may disclose your health information to an insurance or managed care company, Medicare, Medicaid or another third party payor. For example, we may contact Medicare or your health plan to confirm your coverage or to request approval for a proposed treatment or service.
- For Health Care Operations:
We may use and disclose your health information as necessary for our internal operations, such as for general administration activities and to monitor the quality of care you receive with us. For example, we may use your health information to evaluate and improve the quality of care you received, for education and training purposes, and for planning for services.
III. OTHER USES AND DISCOLOSURES WE MAY MAKE WITHOUT YOUR WRTTEN AUTHORIZATION
Under the Privacy Regulations, we may make the following uses and disclosures without obtaining a written authorization from you:
- As Required by law
We may disclose your health information when required by law to do so.
- Facility Directory
Unless you object, we may use and disclose certain limited information about you in our directory while you are a patient. This information may include your name, your location in the facility, your general condition and your religious affiliation. Our directory does not include specific medical information about you. We may disclose directory information, except for your religious affiliation to people who ask for you by name. We may provide the directory information, including your religious affiliation, to a member of the clergy.
- Persons Involved in your Care or Payment for your Care
Unless you object, we may disclose health information about you to a family member, close personal friend or other persons you identify, including clergy who are involved in your care. These disclosures are limited to information relevant to the person’s involvement in your car or in arranging payment for your care.
- Public Health Activities
We may disclose your health information for public health activities.
- Reporting Victims of Abuse, Neglect or Domestic Violence
If we believe that you have been a victim of abuse, neglect or domestic violence, we may disclose your health information to notify a government authority, if authorized by law or if you agree to the report.
- Health Oversight Activities
We may disclose your health information to a health oversight agency for actives authorized by law. A health oversight agency is a state or federal agency that oversees the health care system. Some of the actives may include, for example, audits, investigations, inspections and licensure actions.
- Judicial and Administrative Proceedings
We may disclose your health information in response to a court or administrative order. We may also disclose information in response to a subpoena, discovery request or other lawful process.
- Law Enforcement
We may disclose your health information for certain law enforcement purposes, including for examples, to file reports required by law or to report emergencies or suspicious deaths; identify or locate a suspect or missing person; or to answer certain requests for information concerning crimes.
- Coroners, Medical Examiners, Funeral Directors, Organ Procurement Organizations
We may release your health information to a coroner, medical examiner, funeral director and if you are an organs and tissues donor.
Your health information may be used for research purposes, but only if :(1) the privacy aspects of the research purpose, but reviewed and approved by a special privacy Board or Institutional Review Board, and the Board can legally waive patient authorizations otherwise required by the Privacy Regulations: (2) the researcher is collecting information for research proposal; (3) the research occurs after your death; or (4) if you give written authorization for the use or disclosure.
- To Avert a Serious Threat to Health or Safety
When necessary to prevent a serious threat to your health or safety, or the health or safety, or the health or safety of the public or another person, we may use or disclose your health information to someone able to help lessen or prevent the threatened harm.
- Military and Veterans
If you are a member of the armed forces, we may use and disclose your health information as required by military command authorities. We may also use and disclose health information about you if you are a member of a foreign military as required by the appropriate foreign military authority.
- National Security and Intelligence Activities; Protective Services for the Patient and Others
We may disclose health information to authorized federal officials conducting national security and intelligence activities or as needed to provide protection to the President of the United States, certain other persons or foreign heads of states, or to conduct certain special investigations.
- Inmates/Law Enforcement Custody
If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may disclose your health information to the institution or official for certain purposes, including your own health and safety as well as that of others.
- Worker’s Compensation
We may use or disclose your health information to comply with laws relating to workers’ compensation or similar programs.
- Disaster Relief
We may disclose health information about you to an organization assisting in a disaster relief effort.
- Treatment Alternatives and Health-Related Benefits and Services
We may use or disclose your health information to inform you about treatment alternatives and health-related benefits and services that may be on interest to you.
- Business Associates
We may disclose your health information to our Business Associates under a Business Associate Agreement
IV. YOUR WRITTEN AUTHORIZATION IS REQUIRED FOR ALL OTHER USES OR DISCLOSURES OF YOUR HEALTH INFORMATION
- We will obtain your written authorization (an “authorization”) prior to making any use or disclosure other than those described above.
- A written authorization is designed to inform you of a specific use or disclosure other than those set forth above that we plan to make of your health information. The authorization describes the particular health information to be used or disclosed and the purpose of the use or disclosure. Where applicable, the written authorization will also specify the name of the person to whom we are disclosing the health information. The authorization will also contain an expiration date or event.
- You may revoke a written authorization previously given by you at any time, but you must do so in writing. If you revoke your authorization, we will no longer use or disclose your health information for the purposes specified in thaw authorization except where we have already taken actions in reliance on your authorization.
V. YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION
- Right to Request Restrictions
You have the right to request that we restrict the way we use or disclose your health information for treatment, payment or health care operations. However, we are not required to agree to the restriction. If we do agree to a restriction, we will honor that
restriction except in the event of an emergency, and will only disclose the restricted information to the extent necessary for your payment.
- Right to Request Confidential Communications
You have the right to request that we communicate with you concerning your health matters in a certain manner or at a certain location. For example, you can request that we only speak with you in your room. We will accommodate your reasonable requests.
- Right of Access to Personal Health Information
You have the right to inspect and upon written request, obtain a copy of your health information. Under Connecticut law, if the facility makes a copy of your medical record, we will not charge more than $.65 per page, plus postage if appropriate.
- Right to Request Amendment
You have the right to request that we amend your health information. Your request must be made in writing and must state the reason for the requested amendment. We may deny your request for amendment if the information: (a) was not created by us, unless you provide reasonable information that the originator of the information is no longer available to act on your request; (b) is not part of the health information maintained by us; or (c) is already accurate and complete, as determined by us.
If we deny your request for amendment, we will give you a written denial notice, including the reasons for the denial. In that event, you have the right to submit a written statement disagreeing with the denial. Your letter of disagreement will be attached to your medical record.
- Right to an Accounting of Disclosures
You have the right to request an “accounting” of certain disclosures of your health information. This is a listing of disclosures made by us or by others on our behalf, but does not include disclosures for treatment, payment and health care operations, or certain other exceptions. You must submit your request in writing and you must state the time period for which you would like the accounting. The accounting will include the disclosure date; the name of the person or entity that received the information and address, if known; a brief description of the information disclosed; and a brief statement of the purpose of the disclosure. The first accounting provided within a 12-month period will be free; for further requests, we may charge you our costs for completing the accounting.
VI. SPECIAL REGULATIONS REGARDING DISCLOSURE OF PSYCHIATRIC AND HIV-RELATED INFORMATION
For disclosure concerning certain health information such as HIV-related information or records regarding psychiatric care that have been sent to us by another provider, special restrictions apply. Generally, we will disclose such information only with an authorization, or as otherwise required by law.
- If you believe that your privacy rights have been violated, you may file a complaint in writing with us or with the Office of Civil Rights in the U.S. Department of Health and Human Services at 200 Independence Avenue, S.W., Room 509 F, HHH Building, Washington, D.C. 20201.
- To file a complaint with us, you should contact the administrator of West Hartford Health & Rehabilitation Center.
- We will not retaliate against you in any way for filing a complaint against the facility.
At West Hartford Health & Rehabilitation Center (the “Facility”), we take your privacy seriously. As a result, we have adopted the following policies and procedures to protect the confidentiality of personal information, including Social Security numbers (“Personal Information”) in our possession, and to limit access to and to prohibit the unlawful disclosure of this information:
- The Facility will not disclose to any other person or entity Personal Information without prior written consent or unless otherwise required or permitted by law.
- Personal Information is defined to include information that is capable of being associated with a particular individual through one or more identifiers and includes social security numbers, driver’s license number, a state identification card number, or a health insurance identification number.
- The Facility will take reasonable measures to physically secure Personal Information.
- Access to Personal Information is strictly limited to Facility employees with a business need to access such information. These employees may not disseminate Personal Information to any other employee or to any third party, except to fulfill a necessary business function of the Facility, without prior written consent or unless otherwise required or permitted by law.
- The Facility destroys all documents containing Personal Information prior to disposal.
- The Facility erases all computer hard drives containing Personal Information prior to replacing its computers.
- Violations of this policy will result in disciplinary action, up to and including, termination. Violators may also be subject to civil or criminal penalties.
For information on our privacy protections for patient social security information, please refer to our Notice of Privacy Practices and HIPAA policies and procedures.